Broken Heart Syndrome

What Is

Broken heart syndrome is a condition in which extreme stress can lead to heart muscle failure. The failure is severe, but often short-term.

Most people who experience broken heart syndrome think they may be having a heart attack, a more common medical emergency caused by a blocked coronary (heart) artery. The two conditions have similar symptoms, including chest pain and shortness of breath. However, there’s no evidence of blocked coronary arteries in broken heart syndrome, and most people have a full and quick recovery.

Overview

Broken heart syndrome is a recently recognized heart problem. It was originally reported in the Asian population in 1990 and named takotsubo cardiomyopathy (KAR-de-o-mi-OP-ah-thee). In this condition, the heart is so weak that it assumes a bulging shape (“tako tsubo” is the term for an octopus trap, whose shape resembles the bulging appearance of the heart during this condition). Cases have since been reported worldwide, and the first reports of broken heart syndrome in the United States appeared in 1998. The condition also is commonly called stress-induced cardiomyopathy.

The cause of broken heart syndrome is not fully known. In most cases, symptoms are triggered by extreme emotional or physical stress, such as intense grief, anger, or surprise. Researchers think that the stress releases hormones that “stun” the heart and affect its ability to pump blood to the body. (The term “stunned” is often used to indicate that the injury to the heart muscle is only temporary.)

People who have broken heart syndrome often have sudden intense chest pain and shortness of breath. These symptoms begin just a few minutes to hours after exposure to the unexpected stress. Many seek emergency care, concerned they are having a heart attack. Often, patients who have broken heart syndrome have previously been healthy.

Women are more likely than men to have broken heart syndrome. Researchers are just starting to explore what causes this disorder and how to diagnose and treat it.

Broken Heart Syndrome Versus Heart Attack

Symptoms of broken heart syndrome can look like those of a heart attack.

Most heart attacks are caused by blockages and blood clots forming in the coronary arteries, which supply the heart with blood. If these clots cut off the blood supply to the heart for a long enough period of time, heart muscle cells can die, leaving the heart with permanent damage. Heart attacks most often occur as a result of coronary heart disease (CHD), also called coronary artery disease.

Broken heart syndrome is quite different. Most people who experience broken heart syndrome have fairly normal coronary arteries, without severe blockages or clots. The heart cells are “stunned” by stress hormones but not killed. The “stunning” effects reverse quickly, often within just a few days or weeks. In most cases, there is no lasting damage to the heart.

Because symptoms are similar to a heart attack, it is important to seek help right away. You, and sometimes emergency care providers, may not be able to tell that you have broken heart syndrome until you have some tests.

All chest pain should be checked by a doctor. If you think you or someone else may be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9–1–1 for emergency medical care. In the case of a heart attack, acting fast at the first sign of symptoms can save your life and limit damage to your heart.

Outlook

Research is ongoing to learn more about broken heart syndrome and its causes.

The symptoms of broken heart syndrome are treatable, and most people who experience it have a full recovery, usually within days or weeks. The heart muscle is not permanently damaged, and the risk of broken heart syndrome happening again is low.

Other Names

Apical ballooning syndrome

Stress cardiomyopathy

Stress-induced cardiomyopathy

Takotsubo cardiomyopathy

Transient left ventricular apical ballooning syndrome

Causes

The cause of broken heart syndrome isn’t fully known. However, extreme emotional or physical stress is believed to play a role in causing the temporary disorder.

Although symptoms are similar to those of a heart attack, what is happening to the heart is quite different. Most heart attacks are caused by near or complete blockage of a coronary artery. In broken heart syndrome, the coronary arteries are not blocked, although blood flow may be reduced.

Potential Triggers

In most cases, broken heart syndrome occurs after an intense and upsetting emotional or physical event. Some potential triggers of broken heart syndrome are:

Emotional stressors—extreme grief, fear, or anger, for example as a result of the unexpected death of a loved one, financial or legal trouble, intense fear, domestic abuse, confrontational argument, car accident, public speaking, or even a surprise party.

Potential Causes

Researchers think that sudden stress releases hormones that overwhelm or “stun” the heart. (The term “stunned” is often used to indicate that the injury to the heart muscle is only temporary.) This can trigger changes in heart muscle cells or coronary blood vessels, or both. The heart becomes so weak that its left ventricle (which is the chamber that pumps blood from your heart to your body) bulges and cannot pump well, while the other parts of the heart work normally or with even more forceful contractions. As a result the heart is unable to pump properly. (For more information about the heart’s pumping action and blood flow, go to the Health Topics How the Heart Works article.)

Researchers are trying to identify the precise way in which the stress hormones affect the heart. Broken heart syndrome may result from a hormone surge, coronary artery spasm, or microvascular dysfunction.

Hormone Surge

Intense stress causes large amounts of the “fight or flight” hormones, such as adrenaline and noradrenaline, to be released into your bloodstream. The hormones are meant to help you cope with the stress. Researchers think that the sudden surge of hormones overwhelms and stuns the heart muscle, producing symptoms similar to those of a heart attack.

Coronary Artery Spasm

Some research suggests that the extreme stress causes a temporary, sudden narrowing of one of the coronary arteries as a result of a spasm. The spasm slows or stops blood flow through the artery and starves part of the heart of oxygen-rich blood.

Microvascular Dysfunction

Another theory that is gaining traction is that the very small coronary arteries (called microvascular arteries) do not function well due to low hormone levels occurring before or after menopause. The microvascular arteries fail to provide enough oxygen-rich blood to the heart muscle.

Risk Factors

Broken heart syndrome affects women more often than men. Often, people who experience broken heart syndrome have previously been healthy. Research shows that the traditional risk factors for heart disease may not apply to broken heart syndrome.

People who might be at increased risk for broken heart syndrome include:

Women who have gone through menopause, particularly women in their sixties and seventies

People who often have no previous history of heart disease

Asian and White populations

Although these are the characteristics for most cases of broken heart syndrome, the condition can occur in anyone.

Research is ongoing to learn more about broken heart syndrome and its causes.

Screening and Prevention

Researchers are still learning about broken heart syndrome, and no treatments have been shown to prevent it. For people who have experienced the condition, the risk of recurrence is low.

An emotionally upsetting or serious physical event can trigger broken heart syndrome. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.

Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress. Physical activity, medicine, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program.

Also, some of the ways people cope with stress—such as drinking, smoking, or overeating—aren’t healthy. Learning to manage stress includes adopting healthy habits that will keep your stress levels low and make it easier to deal with stress when it does happen. A healthy lifestyle includes following a healthy diet, being physically active, maintaining a healthy weight, and quitting smoking.

Signs, Symptoms, and Complications

All chest pain should be checked by a doctor. Because symptoms of broken heart syndrome are similar to those of a heart attack, it is important to seek help right away. Your doctor may not be able to diagnose broken heart syndrome until you have some tests.

Common Signs and Symptoms

The most common symptoms of broken heart syndrome are sudden, sharp chest pain and shortness of breath. Typically these symptoms begin just minutes to hours after experiencing a severe, and usually unexpected, stress.

Because the syndrome involves severe heart muscle weakness, some people also may experience signs and symptoms such as fainting, arrhythmias (ah-RITH-me-ahs) (fast or irregular heartbeats), cardiogenic (KAR-de-o-JEN-ik) shock (when the heart can’t pump enough blood to meet the body’s needs), low blood pressure, and heart failure.

Differences From a Heart Attack

Some of the signs and symptoms of broken heart syndrome differ from those of a heart attack. For example, in people who have broken heart syndrome:

Symptoms (chest pain and shortness of breath) occur suddenly after having extreme emotional or physical stress.

EKG(electrocardiogram) results don’t look the same as the results for a person having a heart attack. (An EKG is a test that records the heart’s electrical activity.)

Tests show enlarged and unusual movement of the lower left heart chamber (the left ventricle).\

Tests show no signs of blockages in the coronary arteries.

Recovery time is quick, usually within days or weeks (compared with the recovery time of a month or more for a heart attack).

Complications

Broken heart syndrome can be life threatening in some cases. It can lead to serious heart problems such as:

Heart failure, a condition in which the heart can’t pump enough blood to meet the body’s needs

Heart rhythm problems that cause the heart to beat much faster or slower than normal

Heart valve problems

The good news is that most people who have broken heart syndrome make a full recovery within weeks. With medical care, even the most critically ill tend to make a quick and complete recovery.

Diagnosis

Because the symptoms are similar, at first your doctor may not be able to tell whether you are experiencing broken heart syndrome or having a heart attack. Therefore, the doctor’s immediate goals will be:

To determine what’s causing your symptoms

To determine whether you’re having or about to have a heart attack

Your doctor will diagnose broken heart syndrome based on your signs and symptoms, your medical and family histories, and the results from tests and procedures.

Specialists Involved

Your doctor may refer you to a cardiologist. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.

Physical Exam and Medical History

Your doctor will do a physical exam and ask you to describe your symptoms. He or she may ask questions such as when your symptoms began, where you are feeling pain or discomfort and what it feels like, and whether the pain is constant or varies.

To learn about your medical history, your doctor may ask about your overall health, risk factors for coronary heart disease (CHD) and other heart disease, and family history. Your doctor will ask whether you've recently experienced any major stresses.

Diagnostic Tests and Procedures

No single test can diagnose broken heart syndrome. The tests and procedures for broken heart syndrome are similar to those used to diagnose CHD or heart attack. The diagnosis is made based on the results of the following standards tests to rule out heart attack and imaging studies to help establish broken heart syndrome.

Standard Tests and Procedures

EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records the heart’s electrical activity. The test shows how fast your heart is beating and whether its rhythm is steady or irregular. An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.

The EKG may show abnormalities in your heartbeat, a sign of broken heart syndrome as well as heart damage due to CHD.

Blood Tests

Blood tests check the levels of certain substances in your blood, such as fats, cholesterol, sugar, and proteins. Blood tests help greatly in diagnosing broken heart syndrome, because certain enzymes (proteins in the blood) may be present in the blood to indicate the condition.

Imaging Procedures

Echocardiography

Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart and how well your heart chambers and valves are working. Echo also can show areas of heart muscle that aren't contracting well because of poor blood flow or previous injury.

The echo may show slowed blood flow in the left chamber of the heart.

Chest X Ray

A chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart, lungs, and blood vessels. Your doctor will need a chest x ray to analyze whether your heart has the enlarged shape that is a sign of broken heart syndrome.

A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to broken heart syndrome.

Cardiac MRI

Cardiac magnetic resonance imaging (MRI) is a common test that uses radio waves, magnets, and a computer to make both still and moving pictures of your heart and major blood vessels. Doctors use cardiac MRI to get pictures of the beating heart and to look at its structure and function. These pictures can help them decide the best way to treat people who have heart problems.

Coronary Angiography and Cardiac Catheterization

Your doctor may recommend coronary angiography (an-jee-OG-rah-fee) if other tests or factors suggest you have CHD. This test uses dye and special x rays to look inside your coronary arteries.

To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-eh-ter-ih-ZA-shun). A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.

Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels.

Ventriculogram

Ventriculogram is another test that can be done during a cardiac catheterization that examines the left ventricle, which is the heart’s main pumping chamber. During this test, a dye is injected into the inside of the heart and x ray pictures are taken. The test can show the ventricle’s size and how well it pumps blood. It also shows how well the blood flows through the aortic and mitral values.

Treatment

Even though broken heart syndrome may feel like a heart attack, it’s a very different problem that needs a different type of treatment.

The good news is that broken heart syndrome is usually treatable, and most people make a full recovery. Most people who experience broken heart syndrome stay in the hospital for a few days to a week.

Initial treatment is aimed at improving blood flow to the heart, and may be similar to that for a heart attack until the diagnosis is clear. Further treatment can include medicines and lifestyle changes.

Medicines

Doctors may prescribe medicines to relieve fluid buildup, treat blood pressure problems, prevent blood clots, and manage stress hormones. Medicines are often discontinued once heart function has returned to normal.

The good news is that this condition improves very quickly, so with proper diagnosis and management, even the most critically ill tend to make a quick and complete recovery.

Lifestyle Changes

To stay healthy, it’s important to find ways to reduce stress and cope with particularly upsetting situations. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.

Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress. Physical activity, medicine, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program.

Treatments Not Helpful for Broken Heart Syndrome

Several procedures used to treat a heart attack are not helpful in treating broken heart syndrome. These procedures—percutaneous coronary intervention (sometimes referred to as angioplasty), stent placement, and surgery—treat blocked arteries, which is not the cause of broken heart syndrome.

Living With

Most people who have broken heart syndrome make a full recovery within weeks. The risk is low for a repeat episode of this disorder.

Ongoing medical care and adopting a healthy lifestyle can help speed recovery and contribute to a long, healthy life.

Medicines

Some doctors recommend long-term treatment with beta blockers or similar medicines to block the effects of stress hormones on the heart.

Regular Checkups

To check your heart health, your doctor may recommend echocardiography about a month after you’re diagnosed with broken heart syndrome. Talk with your doctor about how often you should schedule follow-up visits.

Managing Stress

Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress. Physical activity, medicine, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program.

Participate in NHLBI Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) leads or sponsors many studies aimed at preventing, diagnosing, and treating heart, lung, blood, and sleep disorders.